“Outcomes associated with corticosteroid dosage in critically ill patients with acute exacerbations of chronic obstructive pulmonary disease,” AJRCCM, 2016, University of Colorado
Question: Is high-dose or low-dose systemic corticosteroid therapy better for intensive care unit (ICU) patients with acute exacerbations of COPD (AE-COPD)?
Study Type: Retrospective cohort study using a large national quality and health care use database.
Study Population: Patients >40 years of age admitted to an ICU and treated with systemic corticosteroids by hospital day 2 for AE-COPD. Patients excluded if steroid dose >1g/day methylpred, OSH tx, re-admission within 30 days of a prior discharge, solid organ transplant, or presence of pulmonary embolism, pneumothorax, shock, or antifungal therapy.
Study Groups: Patients divided into high-dose corticosteroids (>240 mg/day methylpred) and lower-dose corticosteroids (≤240 mg/day methylpred, i.e., 60 mg Q6 hrs or less).
Primary Outcome: In-hospital mortality
Results: 17,239 patients included in analysis. After propensity score matching, there was no difference in the primary outcome between groups. Patients in the lower-dose group had better clinical outcomes (less time on mechanical ventilation, less time in the ICU, less time in the hospital) and less steroid-related complications (decreased insulin requirements and fewer fungal infections).
Caveats: Retrospective design, association ≠ causation, and potential for unmeasured confounding.
Take-home Point: High-dose systemic corticosteroid therapy does not improve outcomes for critically ill patients with AE-COPD and is associated with a higher rate of steroid-related complications.